Technology Guide How to Go Paperless In the Dental Office By: Dr. Larry Emmott -2- Steps to going paperless: • • • • Create the System Stop Making Paper Scan the Incoming Pull Charts for 6-12 Months Create the System: To create a paperless electronic chart you must first examine what you are now storing on paper. Generally the items in the chart fall in one of four categories, personal, financial, treatment or diagnostic. You will need a system to create all of these items in a digital format. The leading practice management systems like Dentrix or Softdent are designed to do just that. They will create and store most of the items in the personal financial and treatment categories. To create digital diagnostic information, the practice will need a digital x-ray system, a digital camera with image management software and a digital perio probing and chart system like the Florida Probe. The only paper items left are what the rest of the world sends. That is paper from insurance companies, specialists, dental labs, other dentists and finance companies. How the heck can you have a paperless office if the world keeps sending you paper? Simply scan it. When some paper arrives that should be kept in the patient record such as a follow up letter from a specialist, the office administrator opens the letter, puts it on the scanner and within seconds the letter is copied into the patient record. The original paper is then shredded. Scanning is a good solution for now. However it won’t be long before we will be using the Internet for all the bits of paper we are still sending and receiving. -3- What does digital mean? In the most literal sense to digitize something means to turn it into digits or numbers. In a more practical sense it means turning something into the electronic language a computer can understand. A digital record is now possible because we have technology to convert everything we used to store in a paper folder to a digital format. This includes data; that is information in the forms of words and numbers. But it also can include pictures and radiographs. We can digitize sounds, movies and even solid objects. Digitized information can be stored, transmitted and manipulated electronically. Dead Wood: It is probably a useful exercise to evaluate your paper system and see what you are doing now that can be eliminated or streamlined with an electronic system. For example many offices find they have a process in place that was set up years ago that made sense at the time but is now no longer useful. However it is still being done because that’s the way we have always done it. Other processes are no longer needed because an electronic record is more efficient. For example it isn’t necessary to make multiple copies of documents needed by many people; the original can be accessed from any computer at any time. It is possible to turn dead tree (paper) information into electronic digital information. There are four ways to create digital information. -4- Create the System Enter it: What this refers to is the process of directly typing or clicking in information. Capture it: Digital capture refers to a process that creates or captures information (usually images) into an electronic format. In dentistry the best examples would be digital photographs and digital radiographs. Scan it: A scanner is a hardware device that converts hard copy papers into soft copy digital information. Import it: Data import does not create new digital information. It is a function that allows users to add already existing digital information to a patient record. The difference between scanning and importing is that scanning starts with a piece of paper. Importing never goes through a paper phase. This concept is a leap of vision for many dentists; who have viewed technology as an endless and unwanted expense that often causes more trouble than it's worth. However if dentists start looking at their technology as not just a local machine but as a component in the big picture; then computer technology and information integration makes more sense. The computer and digital information are essential not only for making internal operations run smoothly but to provide crucial interaction and commerce with specialists, suppliers as well as the patients Guide to Creating Digital Charts -5Item Software Hardware Process Alternative Personal Information Name Address Phone etc. Practice Management Sytstem Keyboard and mouse Type information into patient record Outgoing Paper Correspondence Word Processing Keyboard and mouse Incoming Paper Correspondence Practice Management System Scanner Electronic correspondence e-Mail application like Outlook Keyboard and mouse Forms, Medical Consents etc Practice Management System Keyboard, mouse and scanner Type in letter, print it for mailing, then import it to the patient record. Do not keep a paper copy. Scan the letter, import to patient record and then shred the paper. Type message and send via email with copy or link to patient record. Copy incoming to patient record. Have the patient fill out a paper form, then click or type in essential data to the patient record. Then scan and import the form with a signature to the record. Import information from an electronic source such as a web page or a tablet PC Fill pre-formatted letter from template with data exported from patient record Diagnostics X-Rays Digital Radiography Specific Direct Sensoror and/or Digital Panoramic Place the sensor like a film and directly capture a digital image into a specific electronic record attached to the patient record. Capture a digital image with a phosphor indirect sensor and scan it into the software Photographs Image Management either dental specific or general photographic Digital Camera, a Card Reader and possibly a video capture card Take photos and download them to the image management software. Either link the photos to the patient record or store them as part of the record. Capture a digital image from an intraoral video camera with either a capture card or direct USB digital connection. Perio Probings Practice Management System or perio specific charting software. Electronic Probe like Florida Probe Capture probing depths directly with the probe and foot control. Speak in the probing depths with voice activated perio charting or type in the numbers with a keyboard Treatment Information Tooth Chart Practice management System Mouse and keyboard Speak in conditions with voice activated charting. Treatment History Practice management System Mouse and keyboard Click in tooth conditions and restorations with an on screen chart Chart notes are entered automatically when procedures are completed. The dentist edits the notes as needed Treatment Plans Practice management System Mouse and keyboard Lab slips Practice Management System or Lab specific software. Mouse and keyboard Prescriptions Practice management System Mouse and Keyboard Specialist Referrals Practice management System with word processing or e-Mail Mouse and Keyboard Re-Call Information Practice management System with word processing or e-Mail Mouse and Keyboard Financial Information Insurance Forms Practice Management System Mouse Keyboard and Internet Insurance EOBs Practice Management System Scanner Payment History Practice Management System Mouse and Keyboard Click in proposed restorations and other treatments with an on screen chart. Display selected treatments for patient acceptance. Type in lab procedure or click in data from patient record. Print and send with case. Prescription is linked to patient record choose from menu, print and sign. Note referral in patient record then transfer diagnostics such as radiographs and photos to a word document then print and send with patient Note re-call interval and track automatically within patient record. Create and mail cards as reminders. Select completed procedres from patient record and send eclaim Scan EOB into patient record and shred the paper Enter payments Extract data from electronic record to fill pre-formatted emails and send automatically. Use a tablet PC to directly capture the patient data with electronic writing and import the inofrmation including an electronic signature to the patient record Speak in notes with voice recognition software. Send lab Rx via e-mail or through lab web page with attached photos. Rather than printing send the clinical data and diagnostics to the specialist via e-mail. Rather than printing cards software automatically extracts re-call data and sends e-mail. Print and mail claim Import EOB from e-mail or web page -6- Stop Making Paper Once the system to create all the digital information is in place, you simply stop making paper. Everything new is electronic; everything from the past is paper. If we don't change direction soon, we'll end up where we're going. Professor Irwin Corey One of the common mistakes dentists make with electronic charting is that they only go part way. Sometimes we miss the obvious, it is the old “can’t see the forest for the trees” (dead or alive). In this case the trees are the individual processes that can be used to create digital information. The forest is the paperless record. If all you see are trees then you might use an electronic chart for treatment planning but make progress notes on paper. You might install a digital radiograph system and not link it to other records. You might have a computer up front for finances and scheduling but don’t have computers in the back for charting. The tendency is to concentrate on individual processes or technologies without integrating the process into the whole. For example: The office may use a paper chart in the treatment room during diagnosis to mark future treatment. Then they take the paper chart to the computer and enter everything again. They will use the computer to create an estimate, insurance forms and schedule. Then they will go back to the paper chart to enter procedure notes, back to the computer to take a payment, back to paper for a prescription, back to the computer for the next appointment then back to paper to check the x-rays. What the office ends up with is a mess. Everything is done at least twice, the paper chart is still needed no one is ever sure if something is on paper or in the computer. As a result the computer chart doesn’t save time and money it makes things worse. Another mistake is to gather digital information, such as photographs, but store it in separate software that is not part of the patient’s digital record. To be most effective the digital information must be all part of the same record using either a fully integrated system or linking each system using computer bridges. Time and again the dental office has everything in place to go paperless but they still make paper just because that is the way they have always done it. Overcoming the inertia of change is frequently the most difficult task of going paperless. There is also an element of fear. Often it is the dentist but it may be the staff; one or the other is afraid of what they do not know, the future, so they hold on to what is known, the past. -7- Scan the Incoming How the heck can I have a paperless office if the world keeps sending me paper? I get paper from insurance companies. I get paper from specialists, I get paper form dental labs, I get paper from other dentists. I get paper from finance companies… The answer is scan ‘em. A scanner is a hardware input device that transforms hard copy into digital electronic form. To scan paper any old scanner will do. However if you wish to scan an x-ray the scanner must have a transparency adaptor. Many scanners have a small transparency adaptor designed to scan a single 35mm slide. This is OK for a single x-ray but useless for a panoramic or a full mouth series. Look for a scanner with a large transparency adaptor priced at about $300. Be warned; some vendors will try and sell you a special x-ray scanner for well over $1,000. Using a scanner you can digitize paper documents and then attach them to the patient’s digital record. When some paper arrives that should be kept in the patient record such as a follow up letter from a specialist, the office administrator opens the letter, puts it on the scanner and within seconds the letter is copied into the patient record. The original paper is then shredded. You can use this method to scan and capture x-rays and photos as well as forms and letters. Attention: Based on my experience I know right now some of the practice administrators reading this are saying to themselves, “Oh great another thing for me to do. Scan all the letters. I don’t have time for all this!” Calm down, think it through. What are you doing now with all the letters and EOBs? You open the envelope, glance through the letter, go to the file room, find the proper chart and insert the letter. That will actually take more time than scanning into the digital record. But there is more. When the doctor needs to read the letter he or she asks for the chart and again you need to get up and search it out then take it where it is needed. The fact is using a scanner will not take more time it will save time, lots of time. Depending on the Practice Management System, documents can also be attached to multiple sources such as labs, referral sources, insurance companies or doctors and hygienists. You can then reference the letter from wherever you have a computer running. There is no need to run to the file room and sort through the charts then locate the letter stuffed in the middle of everything else. If you need a hard copy it can be printed or it can be sent electronically via e-mail. -8- Pull Charts for 6-12 Months Going paperless is a process not an event. At first you will need the paper charts on all your patients as you will be referring to the previous paper entries. As time goes on you will need to refer less and less to the old paper records. After a year all the current x-rays will be digital and all the patients recent entries and treatment plans should be digital. It is now possible to stop pulling charts. However at first you will need to refer to the old charts fairly often for entries or x-rays more than a year old. Eventually you will rarely ever need to pull a chart. Do not try and scan in all the old records. Many dentists believe that in order to go paperless they must convert all their old records. This is a huge, time consuming and expensive task with a very limited benefit. At most you may wish to scan the most recent records of patients who are currently under treatment. Going paperless is a process not an event. -9- Dr. Larry Emmott is one of the most entertaining speakers in dentistry and he is considered the leading dental high tech authority in the country. He has over thirty years of experience as a practicing general dentist in Phoenix, AZ. He has addressed hundreds of professional groups and has been a featured speaker at every major US dental meeting. This article is an excerpt from the technology guide “Going Paperless in the Dental Office”. This is one of three books Dr Emmott has written on high tech in the dental office. You can find the full guide here: www.drlarryemmott.com. For more information contact Dr. Emmott at:[email protected] or 602 791-7071 The Future is Coming and it will be Amazing!